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Why a living wage comes before EMS advocacy

Advocate for EMS improvement starting with your agency because a rising tide lifts all boats


"You ever feel like you're just screaming into the void? It gets discouraging sometimes, trying to advocate for professional advancement in EMS, when it seems like all my peers are interested in are stupid tee shirts and 'Racin' the Reaper.' Don't you ever feel like just giving up?"

I've had some variation of this conversation for years. And truthfully, sometimes it does feel like I'm screaming into the void. But then something occurred to me in a conversation with EMS1 columnist Nancy Magee, planning a series of skill-builder workshops for low-volume EMS squads.

Not to put too fine a point on it, but Nancy's topic suggestions were far more, well … elementary than my own. To me, they seemed more like remediation than continuing education, things that skilled EMTs should already know.

"That’s the point," she told me. "You run more calls in two weeks than most of these folks run all year. Things that are second nature to you, they're still wondering if they're making the right decisions. They never run enough to become confident in what they're doing. When you go a week between patients, the nuances of CHF versus COPD presentation are a little more theoretical than real."

And then it struck me. Many of our colleagues will spend their entire careers without ever reaching a comfort zone, whether it be clinical expertise, or in their personal lives, or in professional advocacy. It's hard to think about abstract concepts like professional development when you’re still living paycheck to paycheck and learning your craft from patient to patient.

In 1943, psychologist Abraham Maslow first published his hierarchy of human needs [Figure 1], a theory of psychological health predicated on prioritizing basic needs.


Maslow's hierarchy of human needs. (Photo courtesy of Kelly Grayson)

Maslow theorized that higher needs, such as esteem and self-actualization, are only possible when basic needs such as food, clothing, shelter, sex and safety are met. In his later years, Maslow acknowledged that often these needs are fluid and may exist in the same person simultaneously.

The fact that many, perhaps even a majority, of our colleagues are stuck on the bottom half of that pyramid sometimes escapes the notice of my EMS advocacy colleagues. I myself have condemned the "professional committee members" of EMS who plan strategy from their ivory towers, long since disconnected from the realities of life as a street provider, but I have been guilty of it myself.

Pressing concerns
Sometimes when we feel as if no one but us cares about the direction of our profession, it behooves us to remember that most of the people we’re advocating for have more pressing concerns.

Like a living wage.

Like having enough time off with family and loved ones.

Like not being too fatigued to enjoy intimacy with your spouse.

Like not having to wonder how to obtain, and pay for, the continuing education that allows you to keep your license and provide for your family.

Like having enough emotional energy after your shift ends to share emotions with your family and still have enough left over to begin the next shift with a modicum of compassion.

For those of us who have reached the upper tiers of Maslow's Hierarchy, we can afford the luxury of contemplating the place of EMS in the health care system. We can afford to advocate for greater professional standards and degree requirements. We can advocate for point-of-care testing, prehospital ultrasound and video laryngoscopy because we have developed our clinical skills enough to recognize their limitations.

We plan strategy like generals and lose sight of the fact that most of our colleagues are still just grunts, trying to survive. Lofty ideas and ambitions are more than they can afford. It's not that they don't care, it's that they can't care, not at this stage of their careers.

So what is a disillusioned EMS advocate to do, when no one else seems to care about the future of EMS?

Focus on the present
Focus on the peers you can help right now. Be someone's emotional support. Share your knowledge with your inner sphere of co-workers. Press for better working conditions and salaries, right there at home.

Start with transforming your agency first. Be supportive rather than jealous of those who manage to better their lot because a rising tide lifts all boats.

Do what you can to help your peers secure those basic needs, right here and right now. Help more people climb to the next tier of the pyramid and there will be a lot more of us who can afford to worry about the future.

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